The Effect of Trauma Center Verification Level on Traumatic Brain Injury Outcome After Implementation of the Orange Book


Far West


Riverside Community Hospital

Document Type


Publication Date



Adolescent, Adult, Aged, Aged, 80 and over, Brain Injuries, Traumatic, Clinical Protocols, Databases, Factual, Female, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Quality Indicators, Health Care, Retrospective Studies, Trauma Centers, Young Adult


Emergency Medicine | Neurology | Trauma


BACKGROUND: Previous literature demonstrates mortality discrepancies at Level II vs. Level I centers in patients with isolated Traumatic Brain Injury (TBI). Our hypothesis is that the implementation of the 2014 version of the resources manual ("the Orange Book") is associated with an elimination of this outcome disparity.

METHODS: Utilizing the Trauma Quality Program Participant Use File for 2017, we compared TBI outcomes at ACS Level I vs. Level II centers.

RESULTS: 39,764 records met inclusion criteria where 25,382 (63.8%) were admitted to a Level I center. Level I patients were younger (56.4 vs.59.1 years, p < 0.001) and less likely to have been injured in a single level fall (39.5%vs.45.5%, p < 0.001). The incidence of severe TBI (11.3%vs.10.3%, p < 0.001) was more common. Adjusted mortality at a Level II vs. Level I center were similar [7.8% vs. 8.4%, 0.669].

CONCLUSIONS: Implementation of 2014 version of the ACS resources manual is associated with improved TBI associated mortality in ACS Level II centers relative to their Level I counterparts.

Publisher or Conference

American Journal of Surgery